Research & Education

Midwives’ concerns about a shift of focus to

computers in maternity settings: technology
invading birth
Alison Craswell, Lorna Moxham, Marc Broadbent

ORIGINAL

Introduction and literature review

Information and communication technology (ICT) is moving rapidly into all areas of health care in what
is claimed to be an effort to combat tightening fiscal budgets, rising costs, the ageing population and a
diminishing workforce (Yu & Comensoli 2004, Smedley 2005, Healy et al 2006, Deloitte 2008, Eley et al
2008, Vimarlund & Koch 2012, National eHealth Transition Authority (NEHTA) 2013). Maternity practice
and care delivery are no exception, and increasingly electronic health records (EHR) and the computerisation
of documentation traditionally carried out on paper, are being introduced. One such newly computerised
practice in Queensland, Australia is the entry of data in to the population data set: the perinatal data collection.
Perinatal data are collected across Australia by maternity unit clinical staff to fulfil related mandatory data
requirements (National Perinatal Epidemiology and Statistics Unit 2013). Data collected via the perinatal data
‘form’ serves to monitor patterns of obstetric and neonatal practice and provide information on obstetric and
perinatal outcomes such as mortality rates and congenital abnormalities (Data Collections Unit, Queensland
Health 2012). Since 2009, collection of perinatal data has been transitioning from paper to an electronic
format. Over 80% of perinatal data in Queensland are now collected this way (Craswell et al 2013).

Historically, midwives have entered data into the
woman’s medical record, a paper chart storing
information collected during an admission to
hospital. While introduction of computer systems
has changed the way data are recorded by midwives,
in many maternity work environments the paper
record continues to be the primary source of
information on the mother and baby. As part of the
perinatal data entry process, placing priority on the
paper chart ensures the data are at least recorded
somewhere, enabling later transcription into the
perinatal data system should that be required. This
entry of data is done either by the attending midwife
or by another midwife to whom the job is given.
Such is the importance placed on the collection of
this information, perinatal data coordinators are
appointed in each health care organisation to ensure
data are both complete and validated prior to being
sent monthly to the central data collections’ unit
of the state. In this case, Queensland Health is the
governing body responsible for collection. In some
organisations, the role of collecting and validating
data also encompasses correction of errors.
The perceived medicalisation of childbirth has led
to an increasing presence and use of electronic
equipment in birth suites and maternity units alike
(Johanson et al 2002) and has contributed to the
amplified discourse around technology invading
birth. Midwives, fearing the erosion of their role and
cognisant of the need to focus care on the mother and
baby, have greeted this shift with varying levels of
acceptance (Davies & Iredale 2006, Thompson 2011).
The aim of this research was to understand midwives’
interactions with the computer when collecting and
entering perinatal data. Data presented in this paper
were gathered as part of a larger study. Given the
complexity of the project and due to the impact of
computers on the core of midwifery practice, only an
examination of the theme ‘shifting focus’ is presented
and discussed here. Such an analysis is relevant to
midwives who enter data into computers as part of
their daily work and also to policy makers who need
to include end users into decision making that affects
clinical practice. To the authors’ knowledge, and
following a lengthy examination of relevant literature,
midwives’ attitudes towards and experiences of their
increasing use of computers, including the movement
of perinatal data collection to an eHealth platform
and computerised perinatal data entry into maternity
units, have not been studied.

MIDIRS Midwifery Digest 25:2 2015 147

Research & Education
Research design: participants and methods
Grounded theory methodology (GTM) is a qualitative
method with an inductive orientation. GTM was
purposefully chosen to add a depth of discovery and
understanding that may not have occurred with a
quantitative approach. The voice of the midwife is
considered important as it provides the experiential
and deep understanding required to appreciate
perinatal data collection (Creswell 2007). Purposive
sampling was used to recruit interview participants,
in conjunction with theoretical sampling as analysis
progressed. This approach ensured that data were
captured from participants with relevant knowledge
and experience. Nonprobability sampling (Auerbach
& Silverstein 2003), an accepted method in GTM
(Bluff 2005), was used to recruit participants.
Later, theoretical sampling, an approach that adds
and refines properties and dimensions to acquire
an in-depth understanding of analytical categories
(Urquhart 2013), was used intentionally to gather
data from participants who would fill the gaps in
the developing theory. Interviews were transcribed
verbatim and analysed using a constant comparative
method with a focus on three levels of coding,
as recommended by Glaser (1978): open coding,
selective coding and theoretical coding. The focus
was on developing a substantive theory to explain the
process under examination.
By the completion of the research, 14 midwives and
one health information manager from 12 different
hospitals across Queensland, had participated in
this research. The participants held a variety of
positions within their organisations and used different
148
© JPC-PROD, Fotolia.com
systems for entering perinatal data. They ranged in
experience from midwives at entry level to clinical
nurse consultants and educators. Some participants
also held the position of perinatal data coordinator
for their unit, which gave them the added role of
validating and extracting perinatal data regularly at
the end of an allocated reporting period, to be sent
to the Department of Health in Queensland, the
Government Health agency at state level.
Adhering to GTM, the sample size was not
predetermined but influenced by saturation of the
data, rather than requiring a specific number of
participants to meet the criterion of generalisability
(Pope et al 2000). Saturation occurred following
14 interviews, when no new information emerged
from interviews and the theoretical framework was
sufficiently populated to explain the phenomenon
under study (Glaser 1978). Participants were asked
an initial open-ended, grand tour question, which
was designed to encourage a full, meaningful answer.
The midwives’ own knowledge of and experiences
around the research topic was valued and privileged.
Ethical approval for the research was obtained from
the University of Wollongong Human Research
Ethics Committee with the research design adhering
to the principles of justice, respect and beneficence
(Australian Government 2007). NVivo data
management software (version 8.1) was used to assist
with organisation and management of the data.
Findings
The findings presented here focus on the voice of the
participant. These findings illustrate their expertise
MIDIRS Midwifery Digest 25:2 2015

and experience and demonstrate how their opinions
are valued. Additional terms to explain terminology
have been added in brackets.
Midwifery was perceived by all participants of
this research as a caring profession with a focus
specifically on the mother and baby. However, due
to the nature of computerised perinatal data entry,
participants said that at times this caused a physical
shifting of focus away from the care of the mother
and baby to the machinery; in this case, the computer.
The theme ‘Shifting focus’ is informed by the
categories 1) Focus on machinery and 2) Technology
invading birth, as seen in Figure 1.
Figure 1. Shifting focus
Focus on Technology
machinery invading birth
Shifting focus
Participants described having to move their focus
from the mother to the computer. They described
how they have to deal with this inanimate object as
a separate entity while entering perinatal data. This,
they felt, detracted from the therapeutic relationship
and moved the midwife’s focus from the mother and
baby, to the computer. This change of focus was of
concern:
‘But there’s also a lack of eye contact, a lack of you
know, some women don’t feel like you’re really… like
even when you say at a normal antenatal visit, “I’m
sorry but I have to do some writing so you know
I’m listening to you.” So for me to input onto the
computer at that time would not be right’ (P3).
This perceived lack of attention on the mother
and baby was echoed by other participants who
communicated wanting to focus on the mother’s care
and not the computer, especially in the birth suite:
‘I guess ‘cause when I’m in the room, I’m there with
the woman not with the computer. I don’t want to
get caught up doing that in front of them. Like they
come out to where we actually do it and they can see
that you’re working but I think when they’re in the
room [birth suite] and you’re in the room looking
after them, then you’re there for them and not the
computer stuff’ (P9).
For some participants, knowing that the data had
to be entered into the computer at some stage was
a distraction from care of the woman. Participants
felt that it placed the focus onto the computer. They
thought that some women would accept this, but
others might wonder what the midwife was doing:
MIDIRS Midwifery Digest 25:2 2015
Research & Education
‘I think it would be really horrible in some ways, like
that it becomes all very technical. You lose, you know,
with birth especially, it’s such an emotional, you
know, spiritual event as well as physical, so making
it all more technical sort of puts focus on machinery
and things’ (P1).
Some participants went as far to say that this was
another example of technology invading birth.
Participants were divided over whether computers
in the birth suite or at the bedside in each mother’s
room were appropriate. There was some suggestion
that this was the way things were going with a move
towards paperless hospitals:
‘Eventually the plan is to go all electronic records
anyway. It will need to be in there’ (P11).
Other participants felt computers in the birth suite
were inappropriate:
‘But to actually move it [computer] into the birth
suite I think would be for me intrusive, it’s bringing
technology into a place where technology doesn’t
belong. You know yourself the difference that even
the monitors that we have, now we have to have the
monitors. … it just changes the ambiance. And we’re
talking about the woman being in a primal state
with not many distractions around, [for example] the
Cardiotocograph — it’s exactly that. You’re checking
that it’s recording, you’re checking that you’re getting
an accurate heart rate [rather than focusing on the
woman]’ (P3).
‘But … we’re talking low risk and trying to reduce the
technology in a labour room’ (P12).
Participants were divided about the introduction
of more technology such as computer interfaces,
specifically into areas such as the birth suite. Some
talked about machinery that is already in a birth suite
as distracting from the hands-on care of the labouring
mother. It was communicated that computers to
collect perinatal data added to this distraction.
Although other participants, who also considered a
computer an intrusion, felt that it could be integrated:
‘I think it would depend on how you used it. Like
you would obviously say to the mother that “this is
a computer database that we put your information
in during the course of me looking after you. I will
be popping in some bits and pieces”, and you would
just explain what I am doing and I would hope that
it wouldn’t intrude because it would just be a piece of
equipment in the corner’ (P8).
Participants were also concerned about the
perceptions of visitors and families. They reported
though, that families who readily use technology
within the maternity environment to send photos and
communicate with others may be more amenable to
technology in birth areas.
149
Research & Education
Terms like ‘primal’, ‘emotional’, ‘spiritual’, ‘women-
centred’ and ‘low risk’ were all used by participants
to describe how they felt about labouring women
and their role as midwives, in the birthing process.
Shifting focus from the woman to the computer was
not seen by participants as an optimal situation and
participants described ‘work arounds’, which means
use of a short cut or avoidance of the computer, at
times when they felt it inappropriate. ‘Work around’
practices included recording on paper and later
transcription as well as passing on data entry to
others at the end of the shift. These practices appear
to have led to delays in recording perinatal data,
resulting in data being entered well after the episode
of care, sometimes minutes, hours or even days later.
Additionally, participants communicated their
frustration that the data entered for the perinatal data
collection were also entered on paper. They described
how this duplication occurred often in many different
places and sometimes into several other computer
software systems as well. Such duplication was seen
as repetitive and a waste of precious time that could
have been spent providing hands-on care of the
mother and baby. Some participants wondered why
these data could not simply be entered once and then
used in every instance it may be required:
‘It’s a shame, a lot of the information seems to be very
similar. It would be great to have it all punched in and
then zipped off to…’ (P5).
‘Where it needed to go?’ (Interviewer).
‘…Electronic discharge, zipped off to [programme
name withheld for anonymity]…, zipped off to
perinatal data, you know? It’d be great to be able to
because it really is a lot of duplication’ (P5).
In addition to the organisational requirements
for data entry into several systems, participants
reported that some units collected statistics on their
own births. They considered this was even more
duplication of perinatal data entry into their own
internally developed spreadsheets. The following
participant gave an example:
‘I just keep specs on the types of births, like I
have done from [de-identified facility]. I’ve got a
spreadsheet’ (P1).
‘And is that data from the information
system or hand-collected data you aggregate
yourself?’(Interviewer).
‘Hand data. Just like SVB, water births, forceps’ (P1).
‘Straight out of the birth register?’(Interviewer).
‘Yes because I have to count that every month
anyway’ (P1).
Participants described how this ‘unnecessary’
duplication of data into other locally developed
databases increased their time in front of the
computer and contributed further to their shift in
150
focus from the mother and baby. In addition to such
localised collections, other mandatory computer
software was also in use. This included systems
to record discharge information and the results of
mandatory hearing tests. Participants reported that
while some of this information is recorded within
the perinatal data set, they are also required to enter
it separately into other software systems. This was a
cause of immense frustration:
‘And you know that’s one of my biggest beefs is that
I can’t understand why that electronic discharge
summary can’t be done somehow, I know it’s
probably easier said than done but linked to the
perinatal data. And that’s a lot of the people’s
complaints too is that we’re doing double work,
putting all this information in and then we’ve got to
put it all in again. But I mean that would be a massive
thing to get done, I know that’ (P7).
Despite the frustration it caused, multiple handling
of data, both written and electronic, seemed to be
accepted as a given, something that was unavoidable,
even though participants would clearly prefer another
way. Participants communicated a belief that both
midwives and women were more comfortable with
the traditional method of recording information on
paper. It was also recognised that duplication of data
entry increased the time spent in front of a computer,
contributing to their frustration with the process
of perinatal data entry. This frustration was not
experienced previously when only paper forms were
used.
Discussion
This research found that midwives were concerned
about using computers to enter perinatal data.
Participants felt that it shifted the focus of their
care from the mother and baby and increased the
technology used in midwifery settings. Participants in
this research described the care of mothers and babies
as the central feature of their profession. They were
concerned about the change that ICT brought to that
integral component of midwifery care.
As maternity care moves further into the 21st century,
dependence on, and use of, technology will increase
(Hodnett et al 2005, Foureur et al 2010). As early as
1990, Paneth (1990) questioned whether investment
in technology was worthwhile, given the cost, both
financially and in terms of human resources, of its
presence where it may not be needed. Jolles et al
(2012:316) stated: ‘Decades of high-quality research
have demonstrated iatrogenic harm involved with
the overuse of technology in the physiologic birth
process.’ This assertion is validated by Cochrane
systematic reviews in this area (Devane et al 2012,
Alfirevic et al 2013). Further research investigating
increasing technology in the birth suite found that
midwives face new dilemmas in dealing with such
technology and, as indicated by these findings, have
MIDIRS Midwifery Digest 25:2 2015

difficulty determining when it is helpful and when it
is not needed (Hyde & Roche-Reid 2004, Blaaka &
Schaurer 2008). Alternatively, it has been suggested
that making computers more accessible in the
workplace for point-of-care data entry will result in
less fear about their use detracting from hands-on
care (Gerrish et al 2006). Midwives in contemporary
practice must deal with the presence of technology
but somehow integrate it into their focus on the
mother and baby.
Historically, midwives have been trained and, more
recently, educated to focus on the holistic care of
women, women-centred care. As a result, midwives
see their role as central to the midwifery model.
Midwifery research has focused on samples of
low-risk women (Cragin & Kennedy 2006), while
women who move out of this normal range when
giving birth are termed high risk and are the focus
of obstetric care. There is no doubt that care of both
low- and high-risk women forms part of the modern
midwifery role in health care organisations, and that
Australia has some of the lowest rates of mortality
and morbidity related to childbirth worldwide
(Australian Institute of Health and Welfare 2011).
However, literature shows that there is an increase in
midwives’ dissatisfaction with the medicalisation of
childbirth, perceiving that it reduces their autonomy
(Gerrish et al 2006, Baker et al 2007). Introduction
of further ‘machinery’, such as computers and other
ICT to record perinatal data adds to the increasing
level of technology involved in the midwife’s role and
in the maternity setting. Sitting in the corner of the
birthing room recording perinatal data on to a paper
collection form, which was common past practice,
is no longer an option for midwives. However, the
introduction of point-of-care computing contributes
to the midwives’ perception that there is a shift in
focus away from direct clinical care. Furthermore,
unless computers are introduced into the birth suite,
either the midwife must leave the room to enter
data or there will be delays in recording data and a
consequent loss of information or inaccuracy in its
recording.
Use of computers for point-of-care perinatal data
entry was reported by some participants to occur in
antenatal clinic settings. A particular concern was that
the focus was on the computer as a separate entity,
when undertaking such data entry, as opposed to the
more traditional focus on the mother. This finding
concurs with other literature involving health care
workers in this area, which has reported that ICT is
perceived as a distraction and as impeding focus on
the admitted client (Kerr & Norris 2008). Health
care workers have reported that using a computer
interface, in this case EHR interferes with eye contact
and communication with patients (Makam et al
2014). Furthermore, a study of nurse practitioners
found that computer use disrupts rapport and
leads to longer consultations (Adams et al 2007).
MIDIRS Midwifery Digest 25:2 2015
Research & Education
Communications between the midwife and mother
are potentially disrupted by the computer interface
and could result in less information transfer via
non-verbal means. An example is body language
that could be easily missed when the midwife’s focus
moves from the mother to the computer.
Previous qualitative research on health service users’
perceptions of the use of EHR showed they felt the
computer was a third entity in communications that
distracted the health care worker from being there
with the patient (Strauss 2013). Kohle-Ersher et al
(2012) reported 10% of patients experience staff
using in-room computers for charting as upsetting.
Staff were described as turning their back to the
client and issues of being disturbed by the light,
noise of tapping keys and computer alert noises
were raised. In contrast, other research has found
use of computer tablets to be beneficial, as they
allow users to maintain eye contact with the patient
while recording admission data (Carlson et al 2010).
The tablet resembles paper recording to the extent
that it does not block the line of vision between the
patient and staff member and minimises disruption to
communication.
Additionally, stress has been experienced as a result of
practising midwifery in a physical environment where
medical technology is embedded (Hammond et al
2013). In introducing new technology, health services
need to be aware of the changes to practice that this
entails and the stress it may cause to both staff and
health service users. News of digital hospitals being
built in Queensland, Australia (Chapman 2012,
Stanley 2013) suggest it is only a matter of time
until much larger ICT integration becomes a reality.
Development and testing of new ICT tools is currently
in progress within maternity practice, for example
handheld interactive electronic maternity records
(Homer et al 2010), which are intended for use as a
cooperative EHR to be shared between mothers and
their range of health care providers during pregnancy.
While such innovations may improve communication
and the portability of information, interoperability
with existing systems needs to be a priority in their
development. Time that could be spent on hands-on
care was reported as being wasted, as the need to
record information both on computers and on paper
meant that data entry was duplicated. This added
to midwives’ time away from new families, and
increased the frustration they experienced regarding
the shift in focus that technology brings to midwifery
practice.
In contrast to the reported shift in focus of care
and concern about increasing technology, some
participants in this research embraced the idea of
further ICT integration, elucidating the advantages
it could bring into midwifery practice. Such diversity
of opinion about technology in maternity units may
stem from past experiences with computers (Baker
151
Research & Education
et al 2007, Hegney et al 2007, Shoham & Gonen
2008). Ubiquitous technology presence within
society and its use within maternity settings was
recognised by participants. However, the findings
have some similarity with previous literature, with
some midwives disliking the idea of the presence of
computers in the birth suite and the effect they believe
this could have on the primal process of birthing.
Increases in technology in birth have already had
an effect on the birthing environment (Foureur et al
2010) and concern has been expressed about further
increases, such as computer use (either desktop,
hand-held or mobile) in the birth suite. Participants
in the current study were concerned that more
technology may impact negatively particularly on the
caring process during birth. For these participants,
midwifery means being ‘with women’ not ‘with
computers’, but the challenge for all midwives is to
find a balance between the two.
Conclusion and recommendations
A variety of users of systems for perinatal data entry
are concerned about the increasing use of technology
in maternity practice leading to a shift in focus
from both the mother and baby and clinical care.
However, some optimism about potential integration
of computers is also being voiced. Midwives who
inevitably and increasingly have to use computers for
perinatal data entry need to consider both the impact
of the technology on the women they are caring
for and how IT can most usefully be integrated.
To successfully move forward in an increasingly
technologically driven society and health care system
means ensuring that are midwives are central to the
development and implementation of technology in
midwifery practice. Incorporating the expertise and
experience of the end user (the midwife) may assist
in this integration. Use of tablet computing may
be a way to facilitate transition to electronic data
entry while maintaining focus on the mother during
consultation. It is recommended that further research
into methods of computer use that are optimal for
both midwives and the women they care for be
undertaken. Research capturing the opinions of
birthing women with regard to ICT is also important.
Acknowledgements
No financial assistance of any kind assisted in
this research.
Dr Alison Craswell PhD, BN, Grad Dip Mid, BA
(Information Management), Post Doctoral Research,
CQUniversity & University of Sunshine Coast.
Professor Lorna Moxham, Professor of Mental Health
Nursing, School of Nursing, University of Wollongong.
Dr Marc Broadbent, Senior Lecturer, School of Nursing and
Midwifery, University of Sunshine Coast.
Correspondence address: Alison Craswell, CQUniversity,
PO Box 1128, Noosaville BC, Q 4566, Australia. Email:
ajc558@uowmail.edu.au
152
References
Adams A, Adams R, Thorogood M et al (2007). Barriers to the use
of e-health technology in nurse practitioner-patient consultations.
Informatics in Primary Care 15(2):103-9.
Alfirevic Z, Devane D, Gyte GML (2013). Continuous
cardiotocography (CTG) as a form of electronic fetal monitoring
(EFM) for fetal assessment during labour. Cochrane Database of
Systematic Reviews, Issue 5.
Auerbach CF, Silverstein LB (2003). Qualitative data: an
introduction to coding and analysis. New York: New York
University Press.
Australian Government (2007). National Statement on Ethical
Conduct in Human Research (2007) – Updated March 2014.
https://www.nhmrc.gov.au/guidelines-publications/e72 [Accessed 18
February 2015].
Australian Institute of Health and Welfare (2011). Maternity
data in Australia: a review of sources and gaps. Bulletin no 87.
Canberra: AIHW.
Baker B, Clark J, Hunter E et al (2007). An investigation of the
emergent professional issues experiences by nurses when working
in an e-health environment. Poole: Bournemouth University. http://
eprints.bournemouth.ac.uk/11732/1/Issues_Project_FINAL_
ED_6Sep07.pdf [Accessed 18 February 2015].
Blaaka G, Schauer ET (2008). Doing midwifery between different
belief systems. Midwifery 24(3):344-52.
Bluff R (2005). Grounded theory: the methodology. In: Holloway
I ed. Qualitative research in health care. Maidenhead: Open
University Press.
Carlson E, Catrambone C, Oder K et al (2010). Point-of-care
technology supports bedside documentation. Journal of Nursing
Administration 40(9):360-5.
Chapman P (2012). Digital hospital a first. Fraser Coast Chronicle,
4 July. http://www.frasercoastchronicle.com.au/news/digital-
hospital-a-first-fraser-coast/1440791/ [Accessed 18 February 2015].
Cragin L, Kennedy HP (2006). Linking obstetric and midwifery
practice with optimal outcomes. JOGNN: Journal of Obstetric,
Gynecologic and Neonatal Nursing 35(6):779-85.
Craswell A, Moxham L, Broadbent M (2013). Computerisation
of perinatal data entry: is the data accurate? Studies in Health
Technology and Informatics 188:7-13.
Creswell JW (2007). Qualitative inquiry and research design:
choosing among five approaches. 2nd ed. London: Sage Publications
Ltd.
Data Collections Unit, Queensland Health (2012). Manual of
instructions for the completion and notification of births to the
Perinatal Data Collection. http://www.health.qld.gov.au/hsu/pdf/
manuals/pdc2012/pdc_instruction_manual_2012.pdf [Accessed 18
February 2015].
Davies J, Iredale R (2006). An exploration of midwives’ perception
about their role. MIDIRS Midwifery Digest 16(4):455-60.
Deloitte (2008). National E-Health and information principal
committee: National E-Health strategy. Canberra: Deloitte Touche
Tohmatsu. http://www.health.gov.au/internet/main/publishing.
nsf/Content/69B9E01747B836DCCA257BF0001DC5CC/$File/
National%20eHealth%20Strategy%20final.pdf [Accessed 19
February 2015].
Devane D, Lalor JG, Daly S et al (2012). Cardiotocography versus
intermittent auscultation of fetal heart on admission to labour
ward for assessment of fetal wellbeing. Cochrane Database of
Systematic Reviews, Issue 2.
MIDIRS Midwifery Digest 25:2 2015

Eley R, Fallon T, Soar J et al (2008). The status of training and
education in information and computer technology of Australian
nurses: a national survey. Journal of Clinical Nursing 17(20):2758-67.
Foureur M, Davis D, Fenwick J et al (2010). The relationship
between birth unit design and safe, satisfying birth: developing a
hypothetical model. Midwifery 26(5):520-5.
Gerrish K, Morgan L, Mabbott I et al (2006). Factors influencing
use of information technology by nurses and midwives. Practice
Development in Healthcare 5(2):92-101.
Glaser BG (1978). Theoretical sensitivity: advances in the
methodology of grounded theory. Mill Valley: Sociology Press.
Hammond A, Foureur M, Homer CSE et al (2013). Space, place
and the midwife: exploring the relationship between the birth
environment, neurobiology and midwifery practice. Women
and Birth: the Journal of the Australian College of Midwives
26(4):277-81.
Healy J, Sharman E, Lokuge B (2006). Australia: health system
review. Health Systems in Transition 8(5):1-158.
Hegney D, Buikstra E, Eley R et al (2007). Nurses and information
technology: an Australian Nursing Federation project funded by
the Australian Government Department of Health and Ageing.
http://anmf.org.au/documents/reports/IT_Project.pdf [Accessed 18
February 2015].
Hodnett ED, Downe S, Edwards N et al (2005). Home-like versus
conventional institutional settings for birth. Cochrane Database of
Systematic Reviews, Issue 1.
Homer CSE, Catling-Paull CJ, Sinclair D et al (2010). Developing
an interactive Electronic Maternity Record: a future concept for
maternity care? British Journal of Midwifery 18(6):384-9.
Hyde A, Roche-Reid B (2004). Midwifery practice and the crisis of
modernity: implications for the role of the midwife. Social Science
and Medicine 58(12):2613-23.
Johanson R, Newburn M, MacFarlane A (2002). Has the
medicalisation of childbirth gone too far? BMJ 324(7342):892-5.
Jolles DR, Brown WW, King KB (2012). Electronic health records
and perinatal quality: a call to midwives. Journal of Midwifery &
Women’s Health 57(4):315-20.
Kerr KA, Norris T (2008). Improving health data quality: a
practitioner’s perspective. International Journal of Information
Quality 2(1):39-59.
Kohle-Ersher A, Chatterjee P, Osmanbeyoglu HU et al (2012).
Evaluating the barriers of point-of-care documentation for nursing
staff. Computers, Informatics, Nursing 30(3):126-33.
Makam AN, Lanham HJ, Batchelor K et al (2014). The good, the
bad and the early adopters: providers’ attitudes about a common,
commercial EHR. Journal of Evaluation in Clinical Practice
20(1):36-42.
MIDIRS Midwifery Digest 25:2 2015
Research & Education
National eHealth Transition Authority (NEHTA) (2013). NEHTA
strategic plan refresh 2011/2012. http://www.nehta.gov.au/
component/docman/doc_download/1338-nehta-strategic-plan-
2011-2012?Itemid= [Accessed 18 February 2015].
National Perinatal Epidemiology and Statistics Unit (2013).
National perinatal data collection. https://npesu.unsw.edu.au/data-
collection/national-perinatal-data-collection-npdc [Accessed 18
February 2015].
Paneth N (1990). Technology at birth [editorial]. American Journal
of Public Health 80(7):791-2.
Pope C, Ziebland S, Mays N (2000). Qualitative research in health
care: analysing qualitative data. BMJ 320(7227):114-16.
Shoham S, Gonen A (2008). Intentions of hospital nurses to
work with computers: based on the theory of planned behavior.
Computers, Informatics, Nursing 26(2):106-16.
Smedley A (2005). The importance of informatics competencies in
nursing: an Australian perspective. Computers Informatics Nursing
23(2):106-10.
Stanley N (2013). Gold Coast University Hospital in final fit-our
phase. Australian Hospital and Healthcare Bulletin, 19th June.
http://www.hospitalhealth.com.au/news/hospital-departments/
gold-coast-university-hospital-in-final-fit-out-phase/ [Accessed 18
February 2015].
Strauss B (2013). The patient perception of the nurse-patient
relationship when nurses utilise an electronic health record within a
hospital setting. Computers, Informatics, Nursing 31(12):596-604.
Thompson H (2011). Promoting normal birth: appropriate use
of intrapartum cardiotocography. British Journal of Midwifery
19(10):625-9.
Urquhart C (2013). Grounded theory for qualitative research: a
practical guide. London: Sage Publications Ltd.
Vimarlund V, Koch S (2012). Identifying where the values
come from IT-innovations in health and social care. Intelligent
Information Management 4:296-308.
Yu P, Comensoli N (2005). Improving healthcare through
informatics. Brunswick, Australia: Health Informatics Society
of Australia.
Craswell A, Moxham L, Broadbent M. MIDIRS Midwifery
Digest, vol 25, no 2, June 2015, pp 147–153.
Original article. © MIDIRS 2015.
153